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January 5, 2012

Taking Smoking Cessation Medication For Several Weeks Before Quitting May Make It Easier To Stay Tobacco-Free

by editor

In this small clinical trial, 53 percent of participants who used varenicline (Chantix) for four weeks before trying to quit were still tobacco-free three months later versus 40 percent of those who took varenicline as usually prescribed, for just one week before quitting.

-- Among women, 67 percent of those who received the extra varenicline before quitting were still smoke-free at follow-up.

-- As predicted, the extra weeks of medication allowed participants to reduce their smoking without increases in craving or withdrawal.

Smokers planning to kick the habit may have more success if they begin using a cessation medication several weeks before they actually try to quit. Those are the results of a clinical trial conducted by researchers at the University at Buffalo Roswell Park Cancer Institute (RPCI) and other institutions published recently in Clinical Pharmacology and Therapeutics.

The study focused on 35 women and 25 men, all smokers from Western New York who were on average 48 years old and smoked a pack of cigarettes per day. Participants who were randomized to take

the smoking cessation medication varenicline (marketed as Chantix) for four weeks prior to trying to quit smoking were more likely to successfully quit smoking than those who took varenicline for just one week before quitting, which is the current standard therapy for the drug. Everyone took the medication for an additional 11 weeks after the quit day.

"Varenicline was designed to make smoking less rewarding, and our data suggests that it does that better when people take it for a few extra weeks before quitting," says Larry W. Hawk, Jr., PhD, lead author and associate professor of psychology in the UB College of Arts and Sciences "If this finding holds up in larger studies, it could have a major impact on public health."

"We saw nearly full compliance, which suggests that this is not only a well-tolerated therapy, but one people can realistically stick with," says co-author Martin C. Mahoney, MD, PhD, associate professor of oncology in RPCI's Departments of Medicine and Health Behavior and clinical associate professor in UB's School of Public Health and Health Professions and School of Medicine and Biomedical Sciences.

While many participants reported mild nausea, Mahoney says, the researchers found that the symptoms typically dissipated after a couple of weeks and may have helped reduce their desire to smoke.

"Whether through changes in taste or nausea, it seems this extra varenicline reduces smoking rates before people try to quit," Hawk says. "These changes should make it easier to quit smoking, but we also know that it takes some period of time for this new learning to occur. That's why we decided to see if a longer period of treatment with varenicline before smokers tried to quit would result in better outcomes, and it did in this small study."

Of special interest was the fact that women who took varenicline for four weeks were especially likely to reduce their smoking, possibly because they reported more nausea in the pre-quit period. After three weeks of treatments with varenicline, women reduced their smoking by more than 50 percent, on average. The men who took the varenicline for four weeks reduced their smoking by 26 percent. The researchers say that much larger studies are needed to tell whether the gender differences are real.

"This study suggests we may be able to take the most effective smoking-cessation treatment we have and make it work 50 percent better, just by giving the medication for a few weeks before smokers attempt to quit," concludes Hawk.

In addition to Hawk and Mahoney, co-authors are Rebecca L. Ashare, PhD, Nicolas J. Schlienz, Stephen T. Tiffany, PhD, Julie C. Gass, Jessica D. Rhodes, all of UB's Department of Psychology; Shaun Fickling Lohnes of Roswell Park, and K. Michael Cummings, PhD, former chair of the Department of Health Behavior at Roswell Park, now at the Medical University of South Carolina.

The study was funded in part by a 2008 Global Research Award for Nicotine Dependence (GRAND), an independent, investigator-initiated research program sponsored by Pfizer, which manufactures varenicline, and by the National Institute for Drug Abuse.

The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.

The mission of Roswell Park Cancer Institute (RPCI) is to understand, prevent and cure cancer. RPCI, founded in 1898, was one of the first cancer centers in the country to be named a National Cancer Institute-designated comprehensive cancer center and remains the only facility with this designation in Upstate New York. The Institute is a member of the prestigious National Comprehensive Cancer Network, an alliance of the nation's leading cancer centers; maintains affiliate sites; and is a partner in national and international collaborative programs. For more information, visit RPCI's website at http://www.roswellpark.org, call 1-877-ASK-RPCI (1-877-275-7724) or email [email protected].